Most people do not even know they are infected. Only a small number of women with high-risk types of HPV will get cervical cancer. The cells go back to normal as the HPV infection clears. In a small number of women, HPV does not go away.
High-grade changes that persist for 1 or 2 years are more likely to become cancer if they are not treated. Factors such as cigarette smoking, a weak immune system , and infection with human immunodeficiency virus HIV are thought to increase the chance that HPV infection will persist, but persistent infections also occur in women without these factors. It usually takes 3 to 7 years for high-grade changes in cervical cells to become cancer.
Cervical cancer screening may detect these changes before they become cancer. Women with low-grade changes can be tested more frequently to see if their cells go back to normal. Women with high-grade changes can get treatment to have the cells removed. Cervical cancer screening saves lives. Over the past 30 years in the United States, the number of cases of cervical cancer and deaths has decreased by one half. This is mainly the result of women getting regular cervical cancer screening.
Cervical cancer screening includes the Pap test, an HPV test, or both. Both tests use cells taken from the cervix. The screening process is simple and fast. You lie on an exam table and a speculum is used to open the vagina. The speculum gives a clear view of the cervix and upper vagina. Cells are removed from the cervix with a brush or other sampling instrument. The cells usually are put into a special liquid and sent to a laboratory for testing:.
Usually, the sample taken for the Pap test also can be used for the HPV test. Sometimes, two cell samples are taken. It depends on the type of Pap test that is used. You should start having screening at age 21, regardless of when you first start having sex. How often you should have cervical cancer screening and which tests you should have depend on your age and health history:.
Women who are 21 to 29 should have a Pap test alone every 3 years. HPV testing alone can be considered for women who are 25 to 29, but Pap tests are preferred.
Women who are 30 to 65 have three options for testing. They can have a Pap test and an HPV test co-testing every 5 years. They can have a Pap test alone every 3 years. Or they can have HPV testing alone every 5 years. The most recent test should have been performed within the past 3 or 5 years, depending on the type of test.
Women who have had a hysterectomy may still need to have screening. The decision is based on whether the cervix was removed, why the hysterectomy was needed, and whether there is a history of severe cervical cell changes or cervical cancer. Even if the cervix is removed at the time of hysterectomy, cervical cells can still be present at the top of the vagina.
If you have a history of cervical cancer or high-grade cervical cell changes, you should continue to have screening for 20 years after the time of your surgery. So women who have been vaccinated against HPV still need to follow the cervical cancer screening recommendations for their age group. Women who have a history of cervical cancer, are infected with HIV, have a weakened immune system, or who were exposed to diethylstilbestrol DES before birth may require more frequent screening and should not follow these routine guidelines.
Cervical cancer is extremely rare in this age group. Fewer than 1 in 1, cases of cervical cancer occur in young women 15 to Most women become infected with HPV shortly after they begin having vaginal intercourse. These infections almost always go away on their own within 1 to 2 years without causing any changes in the cervical cells.
If changes do occur, the cells almost always go back to normal. Research shows that cervical cancer screening in this age group does not reduce the rate of cervical cancer and can lead to unnecessary treatment. Research over the past decades shows that there is no overall advantage to having yearly Pap tests over having Pap tests every 3 years. Yearly Pap tests do find a slightly higher number of cases of cancer than tests performed every 3 years.
But women who have yearly screening undergo many more follow-up tests and treatments for what turns out not to be cancer than women who have testing every 3 years.
A biopsy is the best way to tell for certain if an abnormal area is a pre-cancer, a true cancer, or neither. Several types of biopsies can be used to diagnose cervical pre-cancers and cancers. If the biopsy can completely remove all of the abnormal tissue, it might be the only treatment needed.
For this type of biopsy, first the cervix is examined with a colposcope to find the abnormal areas. The biopsy procedure may cause mild cramping, brief pain, and some slight bleeding afterward. If colposcopy does not show any abnormal areas or if the transformation zone the area at risk for HPV infection and pre-cancer cannot be seen with the colposcope, another method must be used to check that area for cancer.
A narrow instrument either a curette or a brush is inserted into the endocervical canal the part of the cervix closest to the uterus. The curette or brush is used to scrape the inside of the canal to remove some of the tissue, which is then sent to the lab to be checked. After this procedure, patients may feel a cramping pain, and they may also have some light bleeding. In this procedure, also known as conization , the doctor removes a cone-shaped piece of tissue from the cervix.
The base of the cone is formed by the exocervix outer part of the cervix , and the point or apex of the cone is from the endocervical canal. The tissue removed in the cone includes the transformation zone the border between the exocervix and endocervix, where cervical pre-cancers and cancers are most likely to start. A cone biopsy can also be used as a treatment to completely remove many pre-cancers and some very early cancers.
The methods commonly used for cone biopsies are the loop electrosurgical excision procedure LEEP , also called the large loop excision of the transformation zone LLETZ , and the cold knife cone biopsy.
Having had any type of cone biopsy will not prevent most women from getting pregnant, but if a large amount of tissue has been removed, women may have a higher risk of giving birth prematurely. If a biopsy shows that cancer is present, your doctor may order certain tests to see if and how far the cancer has spread.
Many of the tests described below are not necessary for every patient. Decisions about using these tests are based on the results of the physical exam and biopsy. These are most often done in women who have large tumors. They are not necessary if the cancer is caught early. In a cystoscopy, a slender tube with a lens and a light is placed into the bladder through the urethra.
This lets the doctor check your bladder and urethra to see if cancer is growing into these areas. The staging of cervical cancer is the most important factor in determining your treatment plan. The stage of cervical cancer is carefully divided into categories based on the size and spread of cancer beyond the cervix and into other places in the body metastasis , such as the lymph nodes or other organs.
The stages of cervical cancer are:. Read disclaimer about translations Please note that some translations using Google Translate may not be accurately represented and downloaded documents cannot be translated. Dana-Farber assumes no liability for inaccuracies that may result from using this third-party tool, which is for website translation and not clinical interactions.
You may request a live medical interpreter for a discussion about your care. Cervical Cancer. Share Print Email. We provide evaluation and diagnostic services for patients who: Receive an abnormal Pap test result with high-risk HPV Are diagnosed with cervical dysplasia or cervical cancer Require follow-up care due to past Pap test abnormalities Require long-term survivorship care.
If you would like a second opinion You may want to consider a second opinion: To confirm your diagnosis For an evaluation of an uncommon presentation To have your original biopsies or other tissue diagnosis confirmed For details on the type and stage of cancer To better understand your treatment options To learn if you are eligible for clinical trials Phone: DFCI or Online: Complete the Appointment Request Form If you cannot travel to Boston in person, you can take advantage of our Online Second Opinion service.
Tests to examine the cervix Pap test Unlike other gynecologic cancers, cervical cancer can be detected through various screening tests.
Pap test. A speculum is inserted into the vagina to widen it.
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